No abstract

A retrospectively controlled study is described of mortality and serious morbidity in 550 patients treated with corticosteroids and 499 controls. The overall incidence of side-effects was similar in both groups, but gastro-intestinal bleeding, diabetes, and mental disturbance early in treatment occurred more frequently in the corticosteroid group. Other individual side-effects did not occur significantly more often than in the controls, but there was an overall increased frequency of complications with increased dose, and also an increased mortality with increase in the maintenance dose. Gastro-intestinal bleeding was not related to a past or present chronic peptic ulcer, and was not commoner in treated patients. Reactivation of tuberculosis and exacerbation of mental disturbance did not occur. Weight gain occurred in 29% of patients, but appeared to be related closely to a satisfactory response to treatment. Hypertension occurred in 4% of the treated group. Overall mortality in the two groups was similar. Mortality due specifically to corticosteroids was difficult to assess: two patients died of haematemesis and three died with severe asthma during withdrawal of treatment, but there was no increase in mortality following physical stress in the treated series. Sudden death in asthmatics was not more frequent in corticosteroid-treated patients. All seven control patients who died suddenly with asthma were middleaged. Increase in duration of treatment was not associated with increased risk. Indeed the longterm, low-dose group had a lower incidence of complications than the rest and a mortality similar to that of the controls. A trial of corticosteroids for less than one month carried no risk in 41 patients.

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.

Intravenous and oral mexiletine prophylaxis was compared with lignocaine supplemented placebo in a single blind trial in 240 high-risk patients with acute myocardial infarction. Although atrial fibrillation, supraventricular tachycardia and ventricular extrasystoles occurred less frequently in the mexiletine treated patients, ventricular tachycardia and primary ventricular fibrillation were not prevented. Mortality at 6 weeks was less in the mexiletine group (19%) than placebo (27%) but not significantly so (0.2 greater than p greater than 0.1). An 80% chance of showing a significant difference would require 860 high-risk patients. Low plasma mexiletine levels after 3 h treatment were due to diamorphine and may explain failure to prevent major arrhythmias. Pretreatment with intravenous metoclopramide tended to reverse this effect of diamorphine.

The results are described of prolonged corticosteroid treatment in 52 patients with pulmonary sarcoidosis observed for a mean duration of 10-5 years from diagnosis. Twenty of the patients -were treated for less than one year, the remainder for a mean of five years. The mean length of observation after discontinuing treatment was 5*5 years. Selection of patients for treatment was based on (1) evidence from radiographic observation, even for two years or more, that the disease was progressive so that spontaneous remission was improbable; and (2) evidence of disturbed lung function, especially the onset of dyspnoea or an impaired diffusing capacity. Treatment, conveniently with prednisone at a maintenance dose of about 15 mg. daily, should be continued for at least a year and often for much longer until withdrawal is not followed by radiographic relapse. Such treatmnent does not increase the chance of a complete remission even when given at an early stage of the disease; and relief of dyspnoea is unpredictable and seldom considerable. But prolonged treatment will halt progressive lung destruction and appears to curb the eventual mortality.